Clinical outcomes of sirolimus with eluting stent implantation in coronary artery disease

OBJECTIVE: To evaluate the immediate post procedure, thirty-days, and six-months clinical outcomes of sirolimus-eluting stents (SES) implantation in patients with single and multivessel coronary artery disease (CAD). METHODS: A case series of all consecutive patients undergoing percutaneous coronary interventions (PCI) with SES implantation at Shifa International Hospital, Islamabad, were evaluated at early post-procedure, 30-days and six-months clinical follow-up for the incidence of major adverse cardiac event (MACE). This included death, nonfatal myocardial infarction (MI) and repeat revascularization. RESULTS: Out of 206 consecutive patients, 324 had SES implanted. Cumulative MACE rate was 2.93% and 6% at 30-days and six-months follow-ups respectively. Five patients developed ST-segment elevation MI (STEMI). One patient developed non-STEMI. Emergency Coronary Artery Bypass Grafting (CABG) was done in two patients. Repeat (PCI) was carried in three (1.46%) patients for acute in-stent thrombosis. Diabetes Mellitus and multivessel stenting were found to be the independent predictors for acute in-stent thrombosis (P-value \u3c 0.02 and 0.05 respectively). CONCLUSION: SES implantation in coronary artery disease can be safe and effective MACE at one and six months follow-ups

MELD score: utility and comparison with King\u27s College criteria in non-acetaminophen acute liver failure.

Objective: To compare Model for End-stage Liver Disease Score (MELD Score, MS) and King’s College Hospital (KCH) criteria for finding correlation of mortality in non-acetaminophen induced acute liver failure (NAI-ALF). Study Design: An analytical cross-sectional study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 2005 to 2007. Methodology: The study included patients with NAI-ALF. KCH criteria were labelled as good and bad prognosis groups. MELD score were calculated by using the MELD calculator. ROC was plotted and sensitivity analysis was done. ETA was used to see correlation between MELD and KCH. Results: Ninety-one patients with mean age of 32.5 + 16.3 years were studied; 49 were males (54%). Out of these, 57 patients died (63%); two leading causes of non-acetaminophen induced acute liver failure (NAI-ALF) were hepatitis hepatitis B virus (HBV) (n = 30, 33%) followed by hepatitis E virus in (n = 23, 25.3%). According to King\u27s College Hospital (KCH) criteria, 50 patients (88%) who died had bad prognosis and 24 patients (70.6%) who survived had good prognosis. The ROC determined MELD score of 32 was the best predictor of mortality with sensitivity and specificity of 79% and 71%, respectively and positive predictive value (PPV) and negative predictive values (NPV) of 82% and 67% respectively. There was significant association between mortality and bad prognosis according to KCH criteria (p \u3c 0.001). Overall mean MELD score (MMS) was 35.35 + 8.64. MMS on admission was 38 + 7.32 in patients who died and 30.7 + 8.77 in those who survived (p = \u3c 0.001). MMS correlated equally with KCH criteria (ETA = 0.52). Conclusion: The admission MELD score has an excellent utility and correlates equally with KCH criteria for mortality in NAI- ALF

LAPAROSCOPIC CHOLECYSTECTOMY: OUTCOME OF FIRST 202 CASES IN A DISTRICT HOSPITAL IN GILGIT

BACKGROUND: The incidence of gall stone disease is on the rise in Gilgit Baltistan. The objectives of the study were to assess the outcome of laparoscopic cholecystectomy in terms of conversion rate and postoperative morbidity, in The Aga Khan Medical Centre Gilgit. METHODS: It was descriptive case series. All patients that underwent laparoscopic cholecystectomy between June 2009 to May 2014 were included. The data was collected prospectively. Demographic features, operative time, and hospital stay were studied. Postoperative complications were documented and evaluated according to outcome measures (bile duct injuries, morbidity, mortality, conversion rates, wound infections). RESULTS: A total of 202 consecutive patients were enrolled with a mean age of 49±15 years. There were 164 (81%) female and 38(19%.) male patients. Twenty nine (15%) patients had hypertension, 51 (25%) patients had diabetes mellitus as comorbid conditions. The mean operative time was 54±21 minutes. The operative time was longer in 52 (26%) patients. Three patients (1.5%) required conversion to open cholecystectomy due to obscured anatomy in the area of Calot\u27s triangle, and empyema gallbladder. The mean hospital stay was 2±0.7 days. No common bile duct injury, solid organ or bowel injury occurred in this study. The mean follow up duration was 30±15 months. Postoperative complications include, port site infection in 8 (2%) patient, chest infection in 5 (2.4%) patients, and one (0.5%) patient had myocardial infarction. There was no mortality reported in this group of patients. CONCLUSION: Laparoscopic cholecystectomy is a safe procedure with advantages of decreased wound infection, less pain, decreased hospital stay, and early recovery

Frequency and characteristic features of portal hypertensive gastropathy in patients with viral cirrhosis.

To determine the frequency and specific characteristic features of portal hypertensive gastropathy (PHG) in cirrhosis due to viral etiology. Cross-sectional descriptive study. The Aga Khan University Hospital, Karachi, from June 2006 till June 2008. Patients with hepatitis B and C cirrhosis were included who underwent screening esophago-gastroduodenoscopy (EGD) for varices. Baveno III consensus statement was used for diagnosing PHG on endoscopy and divided them into two subgroups i.e. mild and severe. Data related to platelet/spleen ratio, MELD score and Child Turcotte Pugh (CTP) score indicating severity of cirrhosis were recorded in all patients. Findings were compared by using independent sample t-test. Out of 360 patients who underwent screening EGD, 226 (62.8%) were males. Two hundred and eighty one (78%) had hepatitis C while 79 (22%) suffered from hepatitis B related cirrhosis. Three hundred patients (83.3%) had PHG while 71 (24%) had severe PHG. Higher proportion of esophageal varices (89.7%) was present among those who had PHG (p \u3c 0.001). On univariate analysis lower platelet counts (11755 vs. 16790; p \u3c 0.001), increased spleen size (14.12.9 cm vs. 122.4cm; p \u3c 0.001) were found in PHG patients as compared to those without it. Similarly, lower platelet/spleen ratio was noted in patients with severe PHG (916400 vs. 1477899; p \u3c 0.001). Furthermore, on multivariate analysis CTP score \u3e 8 MELD score \u3e 12 and platelets/spleen ratio \u3c 900 were significantly associated factors with severe PHG. Frequency of PHG was 83% while severe PHG was seen in 24% cases of viral hepatic cirrhosis. MELD score \u3e 12, CTP score 8 and platelets/spleen ratio \u3c 900 were significant factors of severe PHG

Exploring The Drivers of Technology Acceptance: A study on Pakistani University Student

The purpose of this study is to validate the technology acceptance model (TAM) in an educational context to explore the drivers of technology on students of Pakistani university. Technologies have extended the teaching quality and open the new doors for the student to make their career highly professional. The data were collected from 508 students through online questionnaire in Pakistan. For analyzing the research model PLS-SEM partial least squares method to structural equation modeling was chosen to analyze the effect of Trialability, Attitude towards technology, Behavior intention, perceived ease of use, perceived enjoyment, facilitating condition, Perceived usefulness, Technology complexity and demographic factors. The gap which we have find is about underprivileged countries that are poor in technology and have not get advancement and success in there so many countries yet. Limitation for this study are we have collected the data from university students. The research is based on descriptive research. Researchers choose a no probabilistic convenience sampling technique to collect data as it is fast, inexpensive and easy. The finding of this study is that all the independent variable has positive and significant relationship with dependent variable. We recommend that future researcher can add more variable to the research and use most updated software version

Spectrum of Different Spinal Disorders Presenting to Neurosurgical Department of Public Sector Tertiary Care Hospitals of Peshawar

Objectives: To assess the spectrum of different spinal disorders presenting to the Neurosurgical department of public sector tertiary care hospitals of Peshawar.Materials and Methods: This was a retrospective study carried out in the Neurosurgery departments of two public sector tertiary care hospitals in district Peshawar from January 2012 to December 2018. Our inclusion criteria comprised of all those patients who were having spinal abnormalities irrespective of age and gender, admitted either via emergency or OPD. We excluded those patients who were dead on arrival or whose data was lacking including those who did not do their follow up and those who were not given consent for the study.Results: Out of total 5,579 patients, male to female ratio was 1:1.7. The age range was from 6 days to 78 years. Elective cases were 63.61% (n = 3,549) and emergency were 36.37% (n = 2,030). TSCI were 35.01% (n = 1,953) and NTSCI were 3,626 (n = 64.99%). Out of all patients, 91.03% (n = 5,079) were treated surgically. About 79% (n = 4,406) had a good outcome.Conclusion: We collected data and made a survey of the spectrum of different spinal abnormalities resulting from various etiologies focused over the last 6 years. We found a variety of cases presenting to our departments of neurosurgery. Non traumatic spinal injuries are more frequent as compared to traumatic ones

Current status of shrimp fishery in Pakistan: economic role, challenges, opportunities and strategies for aquaculture development

1743-1754The Shrimp fishery has an important role in society to meet current and future food, livelihood, employment, business and other economic needs. The capture fishery is one of the largest food-providing sector, whereas aquaculture has emerged as the fastest food-contributing sector globally. This research determines the socio-economic structure of shrimp fishery with a prime objective to expose an overview of shrimp fishery with economic perspective in Pakistan. In addition, further specifying the shrimp capture production, export earnings, farming and socio-impact in coastal region. Indus delta is the most favourable breeding ground for many fish and shrimp species, exhibiting highly rich in natural resources. There is a huge non-agricultural land available along the coast, which can be utilized for aquaculture. This study elucidates that the Shrimp fisheries is ‘Drowning’ in Pakistan. Hence, in order to sustainably develop shrimp aquaculture in Pakistan, this study aims to propose developmental strategies for authorities to establish an extension aquaculture in fisheries department all over the country. In addition, promoting shrimp farming initially at coastal regions to benefit and generate numerous opportunities for sustainable development in country’s livelihood

In Vitro Release Studies of Diclofenac Potassium Tablet from Pure and Blended Mixture of Hydrophilic and Hydrophobic Polymers

The purpose of the present study was to evaluate the effect of pure and blended mixtures, with different compositions of hydroxy propyl methyl cellulose (HPMC) and carnauba wax (CW) on the release of diclofenac potassium from matrix tablets. Fifteen different matrix tablet formulations were prepared by direct compression process by using Carver Hydraulic laboratory press having 13 mm flat dies set at constant pressure. The paddle dissolution apparatus II (Curio DL 2020) was used to assess the dissolution of drug in phosphate buffer, pH 7.4 for 8 h. The release data was fitted to different release models. Zoom stereo micrography was done to evaluated the release mechanism of drug from polymers. The interaction of polymer mixture and different ratios of drug in polymer mixture was determined by Fourier transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC). The type and content of polymer in the matrix system influenced the release characteristics. Higher polymeric content in the matrix decreased the drug release rate because of increased tortuosity and decreased porosity. Retardation of drug release from pure carnauba was higher as compared to that with pure HPMC matrices. The polymers blends controlled drug release pattern effectively. The drug released showed better linearity with Higuchi release kinetics. The Korsmeyer equation revealed n value ranged from 0.388-0.627 or non - Fickian transport mechanism of drug release was predominant. The FTIR and DSC suggested that there were no chemical interaction between drug and polymers.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Corn-Soybean Intercropping Improved the Nutritional Quality of Forage Cultivated on Podzols in Boreal Climate

Intercropping systems could be a potential source of nutrient-rich forage production in cool climates on podzolic soils common in boreal ecosystems. In this study, we evaluated the effects of corn–soybean intercropping (IC) on the nutritional quality of forage. Two silage corn varieties were cultivated as monocropping (MC) or were intercropped with three forage soybean varieties using a randomized complete block design. IC significantly increased the crude protein (22%) and decreased the acid detergent (14%) and neutral detergent (6%) fibers. Forage net energy, total digestible nutrients, ash, dry matter intake, digestible dry matter and relative feed value were also significantly increased (p ≤ 0.05) in the IC treatments compared to corn MC. The macro and micro nutrients were higher in IC than corn MC. Intercropping increased the omega 3 fatty acid (FA) contents (67%) compared to corn MC. IC also increased the active microbial community in the plant root zone, which may contribute to the improvement in forage nutritional quality because the active soil microbial community composition showed significant correlations with soluble sugars, soluble proteins and potassium contents of the forage. These results demonstrate that corn–soybean IC could be a suitable cropping system to increase the nutritional quality of forage cultivated on podzols in boreal climates. The resultant forage has the potential to be a source of high-value animal feed for livestock production in cool climate regions of the world